Peritonitis risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]

Peritonitis Main Page
Patient Information
Overview
Causes
Classification Spontaneous Bacterial Peritonitis Secondary Peritonitis
Differential Diagnosis

Overview

Common risk factors for peritonitis in the development of peritonitis include liver disease, dialysis, and abdominal trauma.

Risk Factors

The following factors may increase the risk of peritonitis:

• Penetrating trauma to the intestine
• Twisted intestine
• Inflammation of the hollow viscera of the abdomen
• Surgical injuries to the abdominal viscera
• Liver disease (Cirrhosis)
• Pelvic inflammatory disease
• Leakage of sterile body fluids into the peritoneum, such as blood (endometriosis), gastric acid (peptic ulcer), bile( liver biopsy), urine(pelvic trauma), menstruum( salpingitis),pancreatic juice (pancreatitis).
• Peritoneal dialysis
• Extra peritoneal tuberculous infection

Biochemical risk factors

Well-established risk factors for developing an initial episode of SBP are :

• Low ascitic fluid protein level (<1 g/dL)
• Elevated serum bilirubin level (>4 mg/dL)
• Advanced Cirrhosis
• Low levels of 25-hydroxy vitamin D
• Serum albumin level <2.85 g/dL

Clinical risk factors

• Patients with Vatical hemorrhage and GI bleeding associated with Cirrhosis are more prone to develop SBP irrespective of the presence of ascites.

Genetic risk factors

• The Toll-like receptor 2 (TLR2) proteins variants of the NOD2 (nucleotide-binding oligomerisation domain containing gene and Farnesoid X were known to cause SBP.

Pharmacological risk factors

• Proton pump inhibitors (PPI) has been associated with a three-fold increase in the risk and identified as an independent risk factor for SBP in patients with advanced cirrhosis.
• Beta-adrenergic antagonists namely nonselective beta-blocker (NSBB) therapy was found to be protective for SBP.

Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites.

• Low serum sodium levels
• Child-Pugh stage C
• Elevated ascites PMN counts (≥100 cells/μl)
• MELD≥22
• Elevated CRP levels

Common risk factors for peritonitis are described as follows:

Primary Peritonitis	Secondary Peritonitis	Tertiary Peritonitis
Cirrhosis with ascitis Portal hypertension with ascitis Patient with continuous ambulatory peritoneal dialysis (CAPD)	Ruptured gastric ulcer, appendicular abscess or diverticular abscess Inflamatory bowel diseases such as chron's disease or ulcerative colitis with toxic megacolon Pelvic inflamatory disease Recent surgical procedures Recent trauma to the abdomen (e.g. Stab injury or gun shot injury)	Previous history of severe antibiotic use Treatment failure in patients with primary or secondary peritonitis